Low burden of minimal residual disease prior to transplantation in children with very high risk acute lymphoblastic leukaemia: The NOPHO ALL2008 experience.
Marianne IfversenDominik TurkiewiczHanne V MarquartJacek WiniarskiJochen BuechnerKarin MellgrenJohan ArvidsonJelena RasconLenne-Triin KörgveeHans O MadsenJonas AbrahamssonBendik LundOlafur G JonssonCarsten HeilmannMats HeymanKjeld SchmiegelowKim VettenrantaPublished in: British journal of haematology (2019)
The population-based Nordic/Baltic acute lymphoblastic leukaemia (ALL) Nordic Society for Paediatric Haematology and Oncology (NOPHO) ALL2008 protocol combined minimal residual disease (MRD)-driven treatment stratification with very intense first line chemotherapy for patients with high risk ALL. Patients with MRD ≥5% at end of induction or ≥10-3 at end of consolidation or following two high risk blocks were eligible for haematopoietic cell transplantation (HCT) in first remission. After at least three high risk blocks a total of 71 children received HCT, of which 46 had MRD ≥5% at end of induction. Ten patients stratified to HCT were not transplanted; 12 received HCT without protocol indication. Among 69 patients with evaluable pre-HCT MRD results, 22 were MRD-positive, one with MRD ≥10-3 . After a median follow-up of 5·5 years, the cumulative incidence of relapse was 23·5% (95% confidence interval [CI]: 10·5-47·7) for MRD-positive versus 5·1% (95% CI: 1·3-19·2), P = 0·02) for MRD-negative patients. MRD was the only variable significantly associated with relapse (hazard ratio 9·1, 95% CI: 1·6-51·0, P = 0·012). Non-relapse mortality did not differ between the two groups, resulting in disease-free survival of 85·6% (95% CI: 75·4-97·2) and 67·4% (95% CI: 50·2-90·5), respectively. In conclusion, NOPHO block treatment efficiently reduced residual leukaemia which, combined with modern transplant procedures, provided high survival rates, also among pre-HCT MRD-positive patients.
Keyphrases
- free survival
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- randomized controlled trial
- young adults
- peritoneal dialysis
- prognostic factors
- cell cycle arrest
- rheumatoid arthritis
- radiation therapy
- intensive care unit
- risk factors
- cardiovascular disease
- patient reported outcomes
- squamous cell carcinoma
- emergency department
- systemic lupus erythematosus
- single cell
- bone marrow
- pi k akt
- disease activity